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Monday, July 23, 2012

Do you have the equipment to do your job?

Kudos to my new environmental services director Shane Fulford.  When he asked his employees if they had the equipment to do their job, they all looked down.  Not at the floor in disgust, but at their heavy, hard to push, no longer lockable, stainless steel cleaning carts.  The fix was not hard, but had to be recognized, and paid for.  $450 durable plastic cleaning carts.  You should see the smiles.  We all have to have equipment and tools to do our work.

For some of us, we have to have the iPhone or iPad and the latest app to be able to prepare the best meeting minutes.  I remember when we had strict policies on what job positions merited the use of a cell phone, wait a minute, those were bag phones. 

Our job frustration can climb and climb if the basic equipment we need is not made available for our use.  Police officers need patrol cars and working radios.  Firefighters need protective apparel.  The problem is, as leaders we have to make tough decisions about what is affordable in an area where there is an endless request list of equipment and supplies available for purchase.

"Gadgets come from the fertile imagination of a practitioner, are delivered to the greed of the entrepreneur, who have sold the devices without proper research"
                                                                 -Paul B. Magnusen
                                                                    -From the 1938 Scudder Oration
                                                                       "Fundamental versus Gadgets in the Treatment of Fractures"

Given the need of healthcare organizations to limit spending in anticipation of financial cuts from Medicare and Medicaid dollars, healthcare leaders cannot invest in "gadgets" without demonstrated returns on investment.  As revenues per patient visit/discharge go down, expenses per patient visit/discharge must decline as well for healthcare organizations to remain solvent. 

During budget meetings I've been in the middle of a lot of catch 22 situations.  You have to spend the money to create the additional revenue.  However the equipment is so expensive, it takes years to see your return on investment.  Funding is never sufficient to meet the needs.  In many healthcare organizations, equipment purchases get down to patient/staff safety issues before the dollars can be released to make the purchase.  Let's look at a few examples.

1.  Item:  Cleaning carts
     Useful Life:  5 years
     Years in Use  10+ years
     Cost to replace $450 each ($10,500)
     Comments:  Locks are broken
     Regulatory Issues:  Unsecured chemicals
     Safety Issues:  Child Hazard, Suicidal patient hazard

2.  Item:  Replacement of Cardiac Monitor/Defibrillator
     Useful Life:  5 years
     Years in Use: 12 years
     Cost to replace $12,000
     Comments:  Cable sockets not longer working.  Cannot get a clear reading.
     Regulatory Issues:  Undependable equipment
     Safety Issues:  Patient Safety

3.  Item:  Disaster Mobile Tent
     Useful Life:  5 years
     Years in Use: New
     Cost:  $ 3400
     Comments:  Will allow for continued operations in the event of facility loss.
     Regulatory:  Addresses disaster planning

Imagine you have been given a list of 20 items!  OK, we will just talk about these 3.  If you were just given an equipment budget of $15,000 some tough decisions would have to be made.  Do you risk putting off purchasing any disaster equipment for yet another year?  Do you buy some cleaning carts and plan on buying some each year until you eventually eliminate the hazards.  Is item 2 an obvious must have? 

We haven't even talked about capital (usually over $3,000 - $5,000) and non-capital equipment.  The approval processes on these items are totally separate.

In any case, leaders are supposed to be asking the question, Do you have the equipment you need to do your job?  When the answer is no, leaders are to try to make something happen.  Sometimes it is to borrow, sometimes it is to lease, but hopefully it is to provide the tools necessary to do the job.

My hat goes off to the LifeFlight Communicators. They constantly track the position of ground and air ambulances and coordinate a million details.  Do they need equipment to do their jobs?  Just as much as the Environmental Services tech that is keeping our patients and staff safe from a deadly infection.  They both need the appropriate equipment and tools to do their job.

I have gone into some work situations, where the equipment and tools needed were some modest creature comforts.  A break room, a microwave oven, a coffeee maker.  Maybe this fits under "Respect for People" more than "equipment", but a need is a need.  When I am trying to build rapport with my team members, I always want to know about what they need to do their jobs, even if it just to make their break time more of a real break from work.  In one of my prior jobs, the employees had assembled a break room right in the middle of the action area of a busy Level I trauma center.  The designated break room was like a ghost town.  The employees could grab something fast and get back to their patients.  It was a true win/win.  This became integral to the design in the Vanderbilt "A" pod.  The break area is 12 feet from the trauma rooms.

The Marco equation says that Happy employees equal happy customers (Nelson 2010).  Small things such as the temperature of their workspace or having to work on an ailing computer can become big things if left unattended to.  More on questions I ask when I round on employees later.....

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